Kenneth Gerard Fogal, MS VP – Psychologist

Key facts

NPI: 1104800960
Entity type: Individual (NPI type 1)
Primary specialty: Psychologist 103T00000X
License: LP0270 (MN)
Practice address: 318 E Main St
Central Lakes Medical Clinic ,PA
Crosby, MN 56441-1691
Phone: (218) 546-8375
Fax: (218) 546-4400
NPI assigned: Dec 5, 2005
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Master of Science

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	LP0270	MN	Yes

Addresses

Primary practice location

318 E Main St
Central Lakes Medical Clinic ,PA
Crosby, MN 56441-1691

Mailing address

318 E Main St
Crosby, MN 56441-1691
Phone (218) 546-8375

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 13, 2026.

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104800960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 E MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411691",
            "telephone_number": "218-546-8375",
            "fax_number": "218-546-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 E MAIN ST",
            "address_2": "CENTRAL LAKES MEDICAL CLINIC ,PA",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411691",
            "telephone_number": "218-546-8375",
            "fax_number": "218-546-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGAL",
        "first_name": "KENNETH",
        "middle_name": "GERARD",
        "credential": "MS VP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP0270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crosby, MN

All providers in Crosby, MN · Psychologist in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.